Allograft Versus Bioactive Glass (BG-S53P4) in Pediatric Benign Bone Lesions

Abstract

Background:Benign bone cysts in children have a high risk of recurrence after bone grafting. The optimal treatment and filling material for these lesions are currently unknown.Methods:We compared cyst recurrence after intralesional curettage and filling with allograft versus bioactive glass (BG-S53P4; Bonalive) in a randomized clinical trial. The volume of recurrent cyst at 2-year follow-up was the primary outcome.Results:Of 64 eligible children, 51 (mean age, 11.1 years) were randomized to undergo filling of the cyst using morselized allograft (26) or bioactive glass (25). Twelve (46%) of the children in the allograft group and 10 (40%) in the bioactive glass group developed a recurrence (odds ratio [OR] for bioactive glass = 0.79, 95% confidence interval [CI] = 0.25 to 2.56, p = 0.77). The size of the recurrent cyst did not differ between the allograft group (mean, 3.3 mL; range, 0 to 13.2 mL) and the bioactive glass group (mean, 2.2 mL; range, 0 to 16.6 mL, p = 0.43). After adjusting for the type of lesion (aneurysmal bone cyst versus other), bioactive glass also did not prevent larger (>1 mL) recurrent cysts (adjusted OR = 0.42, 95% CI = 0.13 to 1.40, p = 0.16). The Musculoskeletal Tumor Society score improved significantly (p ≤ 0.013) from preoperatively to the 2-year follow-up in both groups (to 28.7 for bioactive glass and 29.1 for bone graft). Four (15%) of the children in the allograft group and 6 (24%) in the bioactive glass group required a reoperation during the follow-up (OR for bioactive glass = 1.74, 95% CI = 0.43 to 7.09, p = 0.50).Conclusions:Filling with bioactive glass and with allograft in the treatment of benign bone lesions provided comparable results in terms of recurrence and complications.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Biodegradable biomaterials in orthopedic surgery: A narrative review of the current evidence

“…Then again, challenges due to hard mixture of biomaterial and newly formed bone in reoperation have been reported. 22 Bone grafts are routinely used in spine surgery to achieve rigid fusion between the vertebrae. A frequently used technique is posterior spinal fusion with or without instrumentation, in which bone grafts are applied to the transverse processes to fuse the adjacent vertebrae together.…”

“…Then again, challenges due to hard mixture of biomaterial and newly formed bone in reoperation have been reported. 22…”

“…BG granules and autologous and allogeneic bone grafts resulted in similar overall rates of treatment success. Syvänen et al 22 studied the outcomes of 51 pediatric patients with benign bone tumors randomized for treatment with either BG-S53P4 or allograft and reported comparable results in 2-year clinical and MRI follow-up with possible reduction in the size of recurring lesions in the bioactive glass group. All studies reported residual glass granules in long-term follow-up imaging, but no adverse events.…”

What’s New in Musculoskeletal Tumor Surgery

“…Patients typically had osseous union within 3 months and excellent postoperative functional outcome scores. Syvänen et al conducted a randomized controlled trial comparing the use of allograft with that of bioactive glass (BG-S53P4; Bonalive) following intralesional curettage of benign bone cysts in 51 pediatric patients 23 . The authors found comparable recurrence and complication rates between the 2 groups.…”

News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020–2023)

“…Syvänen et al performed a randomized clinical trial to compare unicameral bone cyst recurrence after intralesional curettage and filling with morselized allograft ( n = 26) versus bioactive glass ( n = 25). They found that the two materials had comparable recurrence rate (46% and 40%, respectively) and similar rate of complications regardless of the histology of the cyst, unicameral or aneurismal [ 57 ].…”